Dr Ben Anyene, is a Microbiologist, Physician, and Public Health Consultant, and the Chairman, National Vaccine Financing Task Team, in this interview with Ndidi Chukwu of Health Reporters says Nigeria’s Funding for Vaccines can trigger a dramatic boost of the economy.
What is the best way to conceptualize health care delivery in Nigeria?
Once you are able to conceptualize health care delivery as part of development, you focus on making quality health care available. Quality should be in terms of efficiency, lives saved and what will give happiness to mothers and by extension to children. Once you are able to conceptualise it that way, it will be very easy for you to start to see what to do and the cost effectiveness because of limited resources. Because of immunisation, which is the most cost effective public health intervention you can get anywhere and once a child is fully immunised you are guaranteed that illnesses from Tuberculosis to diarrhoea, polio, tetanus, and measles will never happen to the child. If the child will never have them it simply means they will hardly fall ill and it is a huge saving both for the country, for the family and for the child because it simply means those hours that the child will be sick are the times the child should have been in school, if a child spends more time at home being sick than being in school, by the time the child becomes employed and working those illnesses will not catch the child so it is a life time saving for the country. That is why I said they should conceptualise health as a means of economic development.
What major setback do you consider the most challenging for health development?
There are so many challenges in the system. The teaching hospitals are not working, the secondary health system are not working, we have to put things right. In terms of not conceptualising health, the actual focus should be what is considered the disease burden of this country. The disease burden of this country says 70 percent are at the PHC level, what constitutes that disease burden? They are mostly vaccine preventable diseases, a rational person will go for that because if you can stop or eradicate 70 percent of disease burden of this country it simply means 70 percent of the country is healthy. It saves a lot of wealth for the country because it contributes to security and development of the country. If more people are healthy, a lot of challenging issues would have been addressed. We must understand the fact that poverty and health have a vicious circle. If you are very poor it is easy to come down with different kind of illnesses. For the fact that Nigeria does not have a special health insurance scheme, and resources are not available for one to pay for health care, then you see people using money that they could have used for other things to solve housing and water problems that takes people further into poverty. So I think conceptualisation is necessary and that is what I will advise the incoming government to do.
Talking about the incoming government, do you think they will have a good footing for health at a start?
If they just start doing things just because of what people think because people are very selfish, they would prefer to have this new administration to put a teaching hospital where people can go in and have access to comfort and that consumes so much. Now we should be talking of what it cost to fully immunise one child in Nigeria. The figures is about 13,500 naira, and if a child is fully immunised about 9-10 childhood diseases that are vaccine preventable can never come to that child again. The incoming administration will do better if its strengthen health insurance, take full responsibility for vaccine funding and improve our Primary Health Care System.
The sort of funding Nigeria has for Vaccines are mostly donor driven, why does it seems so difficult for Nigeria to continue if the country graduates from these funding?
That is why someone like me is very committed to this vaccine financing task force, because it is actually a shame and embarrassment that four percent of health spent in Nigeria comes from international agencies but that four percent of health spent delivers about 65-70 percent of health care delivery in this country. The question we should start asking is where the Nigeria health is spent. The challenge we are having now is that the country cannot fund its own immunisation cost and how much is it? About 500 million dollars annually. That is what Nigeria needs to make sure we don’t have these challenges that comes and kill innocent children, even meningitis and Nigerian government cannot afford it, the state government cannot afford it, I always say we have 38 governments, and we have this budget it makes us ask questions like what is going on? What is going on is simply in terms of prioritisation, making health a priority, when people talk about wealth creation they don’t even understand what it is about, the initial point for wealth creation is to have a healthy work force. To get a healthy workforce, you have to immunise the people first before any other thing. Immunisation is a preventive thing, so you take preventive methods so that people will not fall sick in the first place. So if Nigeria cannot pay for its immunisation, it is a challenge, by July we will be saying that Nigeria has interrupted Polio transmission, but what people don’t know is that the cost of vaccination against polio in Nigeria is the International organisations that have been paying for that polio war that has been going on in Nigeria not the Federal Government of Nigeria.
But the Federal Government has been taking the commendations, having interrupted polio for months?
The federal Government has not given up to 10 percent funding for Polio, the rest of the cost is from outside Nigeria but it shouldn’t be because government must understand that the people are the ultimate resource that any government can talk about. It is shameful that $500 million for instance this year, the Global Alliance for Vaccine Initiative based in Geneva, have been paying for 60 percent of Nigeria vaccine need for the past 10 years, should that be so? Then the balance of 40 percent that is left, Nigeria cannot pay even that they go cap in hand looking for money all over.
Why is Nigeria graduating from GAVI’s funding for vaccines?
Now because Nigeria has been rebased, first for you to qualify for this kind of international contribution for vaccine you must be from the very low income countries, so Nigeria has always been characterised as a low income country which means you don’t have more than $1,500 per annum, that is for GLI, now Nigeria has rebased and rebased shut us up to $2,800 GLI so because of that Nigeria can no more qualify for that kind of funding for immunisation, so this year we are supposed to pay about $225 million. GAVI is paying 50 percent of that, the remaining money is about 105 million dollars, Nigeria cannot pay, so it is the World Bank that is coming in to pay for that, because everybody is afraid because we know that if we don’t pay this money, and the children are not immunised we go back to square one, there will be stock out as we had about five years ago.
Is the Nigerian Government overwhelmed by the disease burden of the nation that it cannot fund Immunisation?
It is about political commitment, political will, and sometimes misplacement of priorities. I don’t think anybody will be celebrating if by next year, we start witnessing stock out and children are not immunised even polio we are about eradicating will come back. It will not be good for Nigeria especially the incoming administration, it was World Bank that saved Nigeria, what GAVI said is that they will withdraw the money gradually, by reducing our payment by 20 percent every year, so that by 2020 we would have exhausted the 20 percent and from 2021 , Nigeria will be paying 100 percent of the cost of vaccines. This would have taken place in 2015, we said it will affect us, they said ok, we are giving you one year of grace, so in 2015 they paid the normal 50 percent they have been paying, but for next year they will reduce 20 percent out of that and it will continue, now Nigeria is not prepared, for 2015, GAVI paid 50 percent, but Nigeria couldn’t pay the remaining 50 percent, Nigeria was putting up $36 million when we are looking at about 105 million dollars, so World Bank has paid, for 2016, World Bank will not be paying for Nigeria again, and GAVI will reduce by 20 percent, so we have a lot already to pay and nobody is thinking about it now. Vaccine is not something you go off the shelve to buy like panadol, it takes at least six months from placing the order and paying for the order. For vaccine it is paid based on request, it is not manufactured and kept on the shelve for you to go and buy, so we have to make that commitment, I’m saying it , nobody has paid in any money for 2016 vaccines yet and this is the end of May, so if money is not paid on time by January, there will be no vaccine for Nigerian children. What we just be doing, which we do sometimes and nobody know this is to go around where we still have some vaccines left in stock we mop up to move to other places.
Way Forward?
In Nigeria there is already a document that says this is the vaccine need for the country, this is what it is cost, I am also using this opportunity to appeal to the incoming government that once the need for health is conceptualised, the first thing to do is to find money for 2016 immunisation, pay it down. In fact they should even pay the one GAVI is paying because the whole thing will be about $400 million there is no reason why Nigeria cannot pay that. Let it be paid so that we can guarantee for next year, there are also new vaccines that are coming we have to know the cost too, I know it is what Nigeria can do because once we apply our minds to something we try to do them but there is no will and commitment, even the milk of human kindness is not there. Every year in Nigeria about 600 thousand children die because they were not immunised. We should be ashamed that we are losing that number of children every year, our priority should be women and children, when we talk about statistics they will tell you 576,000 women per 100,000 die every year. In terms of numbers, that thing comes to ten plane loads of women of 200,000 in each crashing every week. If one plane crashes in this country it becomes an embarrassment. Can you imagine if 10 planes crash every week in this country and these are planes carrying women who are pregnant or those who just delivered, and through challenges of post-delivery they die, it is so shameful because the statistics they say ok every weekend they go and bury somebody and nobody worries about it, that is how bad it is, and Nigeria has no reason to be number one in that kind of thing. In terms of maternal mortality rate we are number two behind India, in tuberculosis we are number four, in measles and child mortality we are number one. Why should we be, small countries like Liberia, and Rwanda are doing better than Nigeria but that is not the issue. I’m saying as Nigerian, we should have this understanding that health comes first before every other thing and we have to start it from the cradle.
Does the nation have the resources for vaccine, looking at the state of the economy at the moment?
I’m worried because if the resources are not there one would understand, the resources are there but it is the efficiency in the use of resources that we need. It is prioritising the use of resources and effectiveness, because I’m aware that in the physical space there are lot of contending issues, but once the priorities are gotten right no one will be worried. I am happy the Buhari, government coming is talking about change, arresting corruption and poverty, what I have not heard them talk about and wish they will is markers and indicators for measuring their performance in those areas. Because I have been in this system for over 20 years and I tell people that we don’t actually need all the money we spend in this country to perform and get the country to be at the level of upper middle developed countries that is emerging countries like Brazil probably we just need about 50 percent of the money we are using and wasting in this country if it is effectively used. I don’t even buy into the question of the money is not there, the money is there. In my private thoughts, I have asked, why don’t we just dedicate per day the oil production to all the key sectors, health, education and all, for health for instance we dedicate one week, in a day then we produce, 1.5 million barrels and a barrel was over $100 when you multiply $100 to 1.5 million it is a lot of money and that is what we get per day, that will be about $2.5 billion you multiply it by seven days that will give you over $15 billion and in naira it is a lot of money, and that is just seven days and we have 52 weeks in a year, if you do that computation, you will find out that at the end of the day you will still have enough but that is not how to run government. Government is run as an institution, I’m joining those that are calling for a government with a strong institution but I will add strong institution that has critical vision which has the primary goal of seeing that the system is catered for with the resources that are available and we have enough resources here.
